Major Depression

Treatment

A combination of psychotherapy and medication is most helpful. The most commonly prescribed antidepressants are known as selective serotonin reuptake inhibitors (SSRIs). They include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and citalopram (Celexa). They are not without problems, but they are fairly easy to take and relatively safe compared with previous generations of antidepressants.

Regarding side effects, SSRIs are known to cause problems with sexual functioning, some nausea, and an increase in anxiety in the early stages of treatment.

Other effective antidepressants are bupropion (Wellbutrin), venlafaxine (Effexor), mirtazapine (Remeron) and duloxetine (Cymbalta). The older classes of antidepressants, tricyclic antidepressants and monoamine oxidase inhibitors, are still in use. They are as effective as the newer ones and can be very useful when someone has not responded well to other treatments.

It usually takes at least two to six weeks of taking any antidepressant to see improvement. Once the right medication is found, it may take up to a few months to find a proper dose and for the full positive effect to be seen.

In the past several years, investigators have raised concerns about an increased risk of suicide in people taking antidepressants. This problem has remained a focus of research, but the evidence remains hard to interpret. Many experts believe that antidepressants reduce the number of suicides overall. But a very small number of people taking these medications probably do have an unusual reaction and end up feeling much worse rather than better.

Although experts continue to debate the research, clinicians agree that it is important to have your treatment monitored closely and for you to report any troubling symptoms or worsening mood to your doctor immediately.

Sometimes, two different antidepressants are prescribed together. Or a mood stabilizer, such as lithium (sold under several brand names) or valproic acid (Depakene, Depakote), is added. If psychotic symptoms are present, an antipsychotic medication is usually prescribed. These include haloperidol (Haldol), risperidone (Risperdal), ziprasidone (Geodon), aripiprazole (Abilify) and olanzapine (Zyprexa, Zydis).

A number of psychotherapy techniques have been demonstrated to be helpful, depending on the causes of the depression, the availability of family and other social support, and personal style and preference. A technique called cognitive behavioral therapy is designed to help a depressed person recognize negative thinking and teaches techniques for controlling symptoms. Psychodynamic, insight-oriented or interpersonal psychotherapy can help depressed people to sort out conflicts in important relationships or explore the history behind symptoms.

If you suffer from depression, you will benefit from educating yourself about the illness. You could also make use of support that may be available in your community.

In some situations, a treatment called electroconvulsive therapy (ECT) can be a life-saving option. This treatment is controversial, but very effective. In ECT, an electrical impulse is applied to the person's scalp and passes to the brain, causing a seizure. The patient is under anesthesia and is monitored carefully. Medication is given before the procedure to prevent any outward signs of convulsions, which helps to prevent injury. Improvement is seen gradually over a period of days to weeks after the treatment. ECT is the quickest and most effective treatment for the most severe forms of depression, and in most people, it is not more risky than other antidepressant treatments.

Created: 4/27/2004 |
Last Modified: 8/21/2006
From Health A-Z, Harvard Health Publications. Copyright 2006 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.

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